State of the Science Reviews

Oropharyngeal Administration of Colostrum to Extremely Low Birthweight Infants: Theoretical Perspectives
Citation: Rodriguez N.A., Meier P.P., Groer M.W., Zeller J.M. Oropharyngeal Administration of Colostrum to Extremely Low Birth Weight Infants: Theoretical Perspectives. Journal of Perinatology 2009: 1-7.

Introduction: Studies in adults have shown that the oropharyngeal route can be used to effectively and safely administer interferon-a, an immune cell-derived cytokine, to patients who are unable to tolerate its parenteral administration. The mechanism for this appears to be the stimulatory effects of the cytokine, on the oropharyngeal-associated lymphoid tissue system. Own mother’s colostrum (OMC) is rich in cytokines and other mmune agents that provide bacteriostatic, bacteriocidal, antiviral, antiinflammatory and immunomodulatory protection against infection. OMC may be especially protective for the extremely low birth weight (ELBW) infant in the first days of life; however clinical instability typically precludes enteral feedings during this period. Oropharyngeal administration is a potential alternative method of providing OMC. Oropharyngeal administration of OMC may have immunomodulatory effects on the recipient infant, and would be especially beneficial to the ELBW infant who would otherwise remain nil per os during the first days of life
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Preventing, Diagnosing and Managing Slow Weight Gain in The Human Milk-Fed Very Low Birthweight Infant

Citation: Meier P.P., Engstrom J.L., Preventing, Diagnosing and Managing Slow Weight Gain in the Human Milk-fed Very Low Birthweight Infant. Sulla Nutrizione Con Latte Materno 2008: 33-47.

The Evidence: Adequacy of Weight Gain in FHM-Fed VLBW and ELBW Infants: Several studies have suggested that VLBW and ELBW infants may not gain weight as rapidly on FHM as on commercial formula during the first weeks post-birth 1-4,20. However, a limitation of these previous investigations is that the caloric density in the human milk fed to the study infants was not measured directly; instead a default value of 20 calories per ounce for unfortified human milk was assumed 2-4,21,22. In separate research, it is well-documented that human milk from individual pumpings varies markedly in caloric density, primarily as a function of variable lipid content, and is not uniformly 20 calories per ounce22-28. Additionally, after human milk is expressed, the processes of collection, storage, handling, and gavage feeding that are universal in the NICU, reduce baseline lipid content and caloric density29-34. Thus, it is probable thatFHM-fed infants in these previous growth comparison studies did not consistently receive the default caloric values, a factor that would contribute to slower weight gain than for formula-fed cohorts. The following sections review the evidence for the variability in lipid and calories in human milk that is received by the VLBW infant, apply these findings to the clinical management of maternal milk expression and enteral feedings in the NICU, and provide three case studies that exemplify these strategies.

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Evidence-based Practices to Promote Exclusive Feeding of Human Milk in Very Low-birthweight Infants

Citation: Meier P.P., Engstrom J.L. Evidence-based Practices to
Promote Exclusive Feeding of Human Milk in Very Low-birthweight Infants.
Neo Reviews Vol. 8 No. 11, 2007:467-477.

Abstract: Recent studies suggest a dose-response relationship between the amount of fortified human milk (FHM) received by very low-birthweight and extremely low-birthweight infants and protection from select prematurity-specific morbidities. However, the feeding of high doses of FHM in this population often is precluded by insufficient maternal milk volume and the replacement of FHM feedings with calorie-dense infant formulas to achieve adequate weight gain. This article reviews the evidence for preventing, diagnosing, and treating insufficient maternal milk volume and slow infant weight gain while receiving FHM and highlights the utility of incorporating technologies from human milk science, such as maternal milk volume records and the creamatocrit procedure, into routine neonatal intensive care unit practice.

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The Evidence for Use of Human Milk in Very Low-birthweight Preterm Infants

Citation: Patel A.L., Meier P.P., Engstrom J.L. The Evidence for Use of Human Milk in Very Low-birthweight Preterm Infants. Neo Reviews Vol. 8 No. 11, 2007: 459-466.

Abstract: Many small and recently larger studies demonstrate the protective effects of human milk feedings for very low-birthweight (VLBW) infants, resulting in decreased morbidities. These benefits are due to the many unique properties of human milk that function synergistically to protect the infant from infectious, inflammatory, and oxidant injury. However, few VLBW infants in the United States receive maternal milk due to significant economic and social barriers. Additionally, the current research has not identified accurately the amount and timing of human milk feedings that provide maximal protection, which would enable optimal use of this scarce resource. Although the benefits of human milk feedings in VLBW infants have been demonstrated clearly, issues that remain unclear include dosing considerations and the economic implications of providing human milk feedings.

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Increased Lactation Risk for Late Preterm Infants and Mothers: Evidence and Management Strategies to Protect Breastfeeding

Citation: Meier P.P., Furman L.M., Degenhardt M. Increased Lactation Risk for Late Preterm Infants and Mothers: Evidence and Management Strategies to Protect Breastfeeding. Journal of Midwifery & Women's Health Vol. 52 No. 6, 2007: 579-587.

Introduction: Late preterm infants (34 0/7–36 6/7 weeks of gestation) are often cared for in general maternity units by clinicians who have limited experience with the specific needs of these newborns. Although the benefits of human milk are well documented, mothers and their late preterm infants are at risk for poor lactation outcomes. These include early breastfeeding cessation and lactation-associated morbidities, including poor
growth, jaundice, and dehydration. Late preterm infants are more likely than term infants to develop temperature instability, hypoglycemia, respiratory distress, jaundice, feeding problems, and to require rehospitalization in the first 2 weeks postbirth. Breastfeeding can exacerbate these problems, because late preterm infants often lack the ability to consume an adequate volume of milk at breast, and their mothers are at risk for delayed lactogenesis. This article reviews strategies to protect breastfeeding for the late preterm infant and mother dyad by establishing and maintaining maternal milk volume while facilitating adequate infant intake. J Midwifery Womens Health 2007;52:579–587 © 2007 by the American College of
Nurse-Midwives.

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Sharing the Science on Human Milk Feedings With Mothers of Very-Low-Birth-Weight Infants

Citation: Rodriguez N.A., Miracle D.J., Meier P.P. Sharing the Science on Human Milk Feedings With Mothers of Very-Low-Birth-Weight Infants. JOGNN 2004 Vol. 34 No. 1, 109-119. 

 

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Supporting Lactation in Mothers With Very Low Birth Weight Infants
Citation: Meier P.P. Supporting Lactation in Mothers With Very Low Birth Weight Infants. Pediatric Annals 32:5 May 2003:317-325. return to top

Executive summary of the workshop “Nutritional challenges in the high risk infant
Citation: Higgins, R. D., Devaskar, S., Hay, W. W., Ehrenkranz, R. A., Greer, F. R., Kennedy, K., Meier, P., Papile, L., & Sherman, M. P. (2012). Executive summary of the workshop “Nutritional challenges in the high risk infant”. Journal of Pediatrics, 160 (3), 511-516. 

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